Clinical Spectrum of Hemolytic Anemia in Loxoscelism - Report of Two Cases Highlighting Variable Severity and Management

Sep 29, 2026

Uploaded by Adam

Loxoscelism from brown recluse spider envenomation can produce both local and systemic illness, including potentially life-threatening hematologic complications. The report presents two loxoscelism-mediated hemolysis cases showing markedly different clinical courses and treatment responses. One patient developed severe hemolytic anemia requiring therapeutic plasma exchange, alongside careful supportive care, while the other had milder disease managed successfully with packed red blood cell transfusion alone. The contrasting severity underscores the need for individualized management guided by clinical presentation and hemolysis pathophysiology.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Case 1

Clinical presentation

Laboratory findings

Diagnosis and management

Case 2

Wiley Case Reports in Hematology Volume 2026, Article ID 9200571, 6 pages [https://doi.org/10.1155/crh/9200571](https://doi.org/10.1155/crh/9200571) Case Report Clinical Spectrum of Hemolytic Anemia in Loxoscelism: Report of Two Cases Highlighting Variable Severity and Management Anas Al-Sadi , 1 Aakriti Adhikari,1 Israa Jawarneh,2 Elrazi Ali,3 and Anuj Shrestha4 1 Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA 2 Department of Medicine, King Abdullah University Hospital, Irbid, Jordan 3 Department of Hematology and Medical Oncology, University of Louisville, Louisville, Kentucky, USA 4 Richard & Annette Bloch Cancer Center, Truman Medical Center, Kansas City, Missouri, USA Correspondence should be addressed to Anas Al-Sadi; [saadeeanas@gmail.com](saadeeanas@gmail.com) Received 22 July 2025; Revised 21 October 2025; Accepted 23 December 2025 Academic Editor: Yoshito Nishimura Copyright © 2026 Anas Al-Sadi et al. Case Reports in Hematology published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Loxoscelism can cause local as well as systemic manifestations. Hematologic complications of brown recluse spider venom can be life-threatening. Here, we present two cases of loxoscelism-mediated hemolysis that highlight the variable clinical presentationsand treatment options available based on severity and pathophysiology of hemolysis. Keywords: complement-mediated hemolysis; corticosteroids; hemolytic anemia; loxoscelism; therapeutic plasma exchange 1. Introduction Loxoscelism, or envenomation by the brown recluse spider, was frst linked to necrotic skin lesions in 1957 [1] . Loxosceles reclusa, the North American brown recluse spider, is primarily distributed in the south-central and Midwest regions of the United States, with limited verifed presence elsewhere [2] . Despite data that suggest Loxosceles reclusa, the North American brown recluse spider, is transported and can be found outside endemic areas, diagnosis of brown recluse spiders outside their areas is very rare [3] . Recluse spiders can be found in areas of high human footprint, such as bedrooms, kitchens, and bathrooms [3, 4], threatening people living in endemic areas. Here, we present two cases of loxoscelism-mediated hemolytic anemia. One case involved severe hemolytic anemia requiring therapeutic plasma exchange (TPE), while the other was milder and managed successfully with support from packed red cell transfusion alone. Tis contrasting severity highlights the clinical variability of loxoscelismrelated hemolytic anemia and the need for individualized management. 2. Case 1 Te frst patient is a 26-year-old male patient who presented to the emergency room with progressive generalized weakness for one week. Fatigue was severe enough to make him unable to carry out his daily physical activity. He also reported difuse arthralgia, chills, and a dry cough. He had reported red urine over the last few days and an itchy, painful skin rash on his back. Two weeks before the presentation, he had a spider bite at the site of the rash. He did not have any signifcant medical or surgical history. He was not on any regular medications. On initial assessment, the patient looked sick and in distress. He was tachycardic at 110 beats/min and tachypneic at 24 breaths/min, and his temperature was 38 °C. Cardiovascular, respiratory, and gastrointestinal system examinations did not reveal any abnormalities. His skin lesion on the back is shown in Figure 1. His initial blood work was remarkable for hemoglobin of 11.0 g/dL, white cell count of 17,600/mm3, platelet counts of 154,000/mm3, international normalized ratio (INR) 1 .43, PTT 34 s, fbrinogen level 210 mg/dL, total bilirubin 2.3, direct bilirubin 1.1, and normal liver and kidney fu

FAQs

What causes hemolytic anemia in loxoscelism according to the report?

Loxoscelism leads to systemic effects from brown recluse spider venom, including complement-mediated hemolysis that can result in hemolytic anemia.

How did the two cases differ in severity and treatment?

One case involved severe hemolytic anemia requiring therapeutic plasma exchange, while the other was milder and was managed successfully with packed red blood cell transfusion alone.

Why is individualized management important in loxoscelism-related hemolytic anemia?

Because clinical presentation and hemolysis pathophysiology vary, the report emphasizes tailoring treatment intensity—such as the use of plasma exchange versus transfusion support—based on disease severity.

Sep 29, 2026

Uploaded by Adam